Noguera H H, Peralta A O, John R M, Venditti F J, Martin D T
Cardiac Electrophysiology Laboratory, Lahey-Hitchcock Medical Center, Burlington 01805, USA.
Heart. 1997 Jul;78(1):50-5. doi: 10.1136/hrt.78.1.50.
To study the potential interactions in patients with endocardial permanent pacemakers and non-thoracotomy implantable cardioverter defibrillator (ICD) systems.
Case series and cohort study.
Tertiary referral centre.
Fifteen consecutive patients with both endocardial pacemakers (12 dual chamber and three single chamber) and non-thoracotomy ICD systems.
Detection inhibition of induced ventricular fibrillation; double counting; and pacemaker function after shocks. In the evaluation of detection inhibition, 124 VF inductions were analysed for detection duration compared with induced VF episodes in controls with an ICD but without a pacemaker.
Two patients (13%) showed detection inhibition of VF and required pacemaker system change at the time of the ICD implant. With the final lead position, despite frequent pacemaker undersensing of VF, ICD detection of VF was not inhibited during any induction, and neither initial detection nor redetection times for VF were different from controls. Double/triple counting of pacemaker artefact and evoked electrogram was noted in three patients (20%). In two, this was remedied during the implantation procedure, and in the other it was abolished when amiodarone treatment was discontinued. Pacemaker function was affected by ICD discharges in two patients, one who showed postshock atrial undersensing and loss of capture, and another whose pacemaker reverted to VVI mode.
When careful testing is performed at implantation to detect and remedy device interactions, non-thoracotomy ICD treatment and endocardial pacemakers can be used safely in combination.
研究心内膜永久起搏器患者与非开胸植入式心律转复除颤器（ICD）系统之间的潜在相互作用。
病例系列和队列研究。
三级转诊中心。
连续15例同时植入心内膜起搏器（12例双腔起搏器和3例单腔起搏器）和非开胸ICD系统的患者。
诱发性室颤的检测抑制；重复计数；电击后起搏器功能。在检测抑制评估中，分析了124次室颤诱发的检测持续时间，并与仅植入ICD而未植入起搏器的对照组诱发的室颤发作进行比较。
2例患者（13%）出现室颤检测抑制，在植入ICD时需要更换起搏器系统。最终电极位置确定后，尽管起搏器频繁出现室颤感知不足，但在任何诱发过程中ICD对室颤的检测均未受到抑制，室颤的初始检测和再次检测时间与对照组相比无差异。3例患者（20%）出现起搏器伪迹和诱发心电信号的双重/三重计数。其中2例在植入过程中得到纠正，另1例在停用胺碘酮治疗后消失。2例患者的起搏器功能受到ICD电击的影响，1例出现电击后心房感知不足和夺获丧失，另1例起搏器恢复为VVI模式。
在植入时进行仔细测试以检测和纠正设备相互作用，非开胸ICD治疗和心内膜起搏器可安全联合使用。
